May 25, 2004

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PENANG, Malaysia, May 24 (IPS) – The Malaysian government’s plan to set up private commercial wings in government-run hospitals to stem the brain drain of doctors to the private sector has come under fire.

Health Minister Dr Chua Soi Lek said a committee, tasked to look into the idea, would come up with a working model within two months. Patients would pay ”reasonable charges” for better facilities at the private wings, such as private rooms with attached bathrooms and television.

The reaction to the plan was swift. ”It is clear that our under-financed government health care will become even less available to the poor,” said Dr Chan Chee Khoon, coordinator of the Citizens’ Health Initiative.

He warned that private wings in state hospitals would lead to human and material resources being reallocated to serve the dictates of the health care market – including ”health tourism” – rather than the needs of the poor

At present, a nominal fee is imposed for treatment in crowded open wards while a higher, though still subsidised, charge is billed for more spacious rooms in general hospitals. Some 80 to 85 percent of Malaysian in-patients obtain treatment in general hospitals.

The proposal for private wings in general hospitals first came in 1997 from the Section Concerning House Officers, Medical Officers and Specialists of the Malaysian Medical Association (SCHOMOS MMA), the body representing government medical doctors.

The aim was to allow government doctors to do private practice to supplement their relatively low salaries. The health ministry however deemed the plan not practical.

The MMA kept the issue alive, believing that limited private practice would help to retain senior and trained staff in the public sector. It felt that doctors, the government and patients would all benefit from this scheme.

In 1999, the MMA brought the matter up with then Prime Minister Mahathir Mohamad and senior health officials were said to be keen on having the proposal implemented by June 2004.

Chua pointed out that 40 percent of the 1,200 positions for specialists and 25 percent of the 10,000 medical-specialist posts had not been filled – a critical shortage. The public-private mix has already been introduced in a few hospitals such as the University Hospital (UH) and the National Heart Institute (IJN) to plug the brain drain to the private sector.

”It has been a disaster so far,” said Dr T Jayabalan, advisor on health care issues to the Consumers Association of Penang.

Drug, procedure, and laboratory charges at the UH has soared, he said. What’s more, ”the IJN is probably the costliest place for heart surgery”, he noted. ”The waiting time for heart patients who are unable to afford surgery could be two years or more.”

Some government doctors who once supported the private wings proposal are having reservations. ”We know among ourselves that there are guys who will abuse it,” said a senior doctor at a government hospital who declined to be named, citing the fear of repercussions.

He said the proposal appears to be targeted at patients who would otherwise go to private hospitals. But in practice, he pointed out that the private wings could end up siphoning patients from the public section of the general hospitals by baiting them with shorter waiting times and superior care.

The key issue is underfunding of public health care, a subject rarely discussed openly in Malaysia.

Expenditure on public health care as a percentage of Gross Domestic Product has traditionally hovered at around 3 percent – well short of the five to six percent proposed by the World Health Organisation. Underfunding is responsible for inadequate facilities, long waiting lists and low salaries.

In the Penang General Hospital, for example, the waiting time for patients needing a Magnetic Resonance Imaging (MRI) brain scan can be up to five months.

Underfunding also means that government doctors remain underpaid — despite their heavy workload. Medical officers routinely see some 150 outpatients a day, when the ideal should be not more than 50.

Such conditions have led to an exodus of staff, prompting the government to hire expatriate Asian and Middle Eastern doctors – and this in turn creates resentment among local government physicians.

The declining standard of nursing care also plagues the health system. ”It is quite common to enter a ward and see patients with soiled clothes and (intravenous) drips running dry,” said Cecilia, an experienced health care worker. ”It is also common to see groups of nurses chit-chatting merrily away while the sick yearn for help.”

At the Penang Hospital for instance, nurses expect visiting family members to change the soiled clothes of bedridden patients and feed them during mealtimes. Services like cleaning, facilities maintenance and the catering of meals for patients have been privatised – leading in some cases to lack of accountability and conflicting responsibilities.

At mealtimes at the hospital, attendants from the private catering firm merely leaves the meal trays at patients’ bedside. An hour later, they come around to collect the trays – whether the patient has touched the food or not.

In one incident, Xavier, an elderly bedridden patient, was unable to sit up and reach for his tray. When the attendant returned and collected the untouched food, it was pointed out to him that the patient had not yet eaten.

The worker merely shrugged his shoulders and said: ”It’s the nurse’s job to see that he is fed. Mine is just to serve the food and collect the utensils after mealtimes. I have to account for each and every item of cutlery – anything missing gets deducted from my wages.”

But one of the more diligent nurses flitting around from patient to patient is Siti. Asked about the indifferent attitude of some of her colleagues, she sighed: ”You have to be like a Florence Nightingale. You have to think about how you would like to be treated if you were in their (the patients’) position.”

Said Siti: ”Many of my colleagues – they are here because they can’t find jobs elsewhere. Their hearts are not in it – it’s just a means of earning a living for them.” (END/2004)